The patient, an 82-year-old man known for gout, calcium pyrophosphate (CPP) deposition (CPPD) disease, alcoholic liver disease and hypertension, presented with acute onset of severe, rapidly progressive pain in both hands. His regular treatment included allopurinol (50 mg daily), with colchicine (0.5 mg) and oral or intra-articular prednisolone for the management of recurrent gout flares and acute CPP crystal arthritis. This article is protected by copyright. All rights reserved.